Successful delayed non-operative management of C2 neurosynchondrosis fractures in a pediatric patient: a case report and review of management strategies and considerations for treatment

详细信息    查看全文

• 作者：Berje Shammassian ; Christina Huang Wright ; James Wright…
• 关键词：Synchondrosis fracture ; Pediatric ; Spine ; Trauma ; Cervical ; Instability
• 刊名：Child's Nervous System
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：32
• 期：1
• 页码：163-168
• 全文大小：649 KB
• 参考文献：1.Akbarnia BA, Yazici M, Thompson GH (2011) The growing spine: management of spinal disorders in young children. Springer, Heidelberg
  2.Blauth M, Shmidt U, Otte D, et al. (1996) Fractures of the odontoid process in small children: biomechanical analysis and report of three cases. Eur Spine J 5:63–70CrossRef PubMed
  3.Botte M, Byrne T, Abrams R, Garfin S (1996) Halo skeletal fixation: techniques of application and prevention of complications. J Am Acad Orthop Surg 4:44–53PubMed
  4.Brown RL, Brunn MA, Garcia VF (2001) Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 36:1107–1114CrossRef PubMed
  5.Cattell HS, Filtzer DL (1965) Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 47:1295–1309PubMed
  6.Connolly B, Emery D, Armstrong D (1995) The odontoid synchondrotic slip: an injury unique to young children. Pediatr Radiol 25(Suppl1):S129–S133PubMed
  7.Dormans JP, Criscitiello AA, Drummond DS, Davidson RS (1995) Complications in children managed with immobilization in a halo vest. J Bone Joint Surg Am 77:1370–1373PubMed
  8.Englander O (1942) Nontraumatic occipito-atlanto-axial dislocation: a contribution to the radiology of the atlas. Br J Radiol 15:341–345CrossRef
  9.Fassett D, McCall T, Brockmeyer D (2006) Odontoid synchondrosis fractures in children. Neurosurg Focus 20(2):E7PubMed
  10.Fesmire F, Luten R (1989) The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med 7:133–142CrossRef PubMed
  11.Fulkerson DH, Hwang SW, Patel AJ, Jea A (2012) Open reduction and internal fixation for angulated, unstable odontoid synchondrosis fractures in children: a safe alternative to halo fixation? J Neurosurg Pediatr 9:35–41CrossRef PubMed
  12.Hadley MN (2002) Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 50:S85–S99CrossRef
  13.Hosalkar HS, Greenbaum JN, Flynn JM, Cameron DB, Dormans JP, Drummond DS (2009) Fractures of the odontoid in children with an open basilar synchondrosis. J Bone Joint Surg (Br) 91(6):789–796CrossRef
  14.Karwacki GM, Schneider JF (2012a) Normal ossification patterns of atlas and axis: a CT study. Am J Neuroradiol 33(10):1882–1887CrossRef PubMed
  15.Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC, Group PECARNPCSS (2014) Cervical spine injury patterns in children. Pediatrics 133:e1179–e1188CrossRef PubMed
  16.Lidar Z, Constantini S, Regev G, Salame K (2012) Absorbable anterior cervical plate for corpectomy and fusion in a 2-year-old child with neurofibromatosis: technical note. J Neurosurg Pediatr 9:442–446CrossRef PubMed
  17.Kalfas I, Wilberger J, Goldberg A, et al. (1988) Magnetic resonance imaging in acute spinal cord trauma. Neurosurgery 23:295–299CrossRef PubMed
  18.Karwacki GM, Schneider JF (2012b) Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol 33:1882–1887CrossRef PubMed
  19.Knox J, Schneider J, Wimberly RL, Riccio AI (2014a) Characteristics of spinal injuries secondary to nonaccidental trauma. J Pediatr Orthop 34:376–381CrossRef PubMed
  20.Knox JB, Schneider JE, Cage JM, Wimberly RL, Riccio AI (2014b) Spine trauma in very young children: a retrospective study of 206 patients presenting to a level 1 pediatric trauma center. J Pediatr Orthop 34:698–702CrossRef PubMed
  21.Mandabach M, Ruge JR, Hahn YS, et al. (1993) Pediatric axis fractures: early halo immobilization, managment and outcome. Pediatr Neurosurg 19(5):225–232CrossRef PubMed
  22.Pang D, Sun PP (2004) Pediatric vertebral column and spinal cord injuries. In: Winn HR (ed) Neurological surgery. WB Saunders, Philadelphia, pp. 3515–3557
  23.Polk-Williams A, Carr BG, Blinman TA, Masiakos PT, Wiebe DJ, Nance ML (2008) Cervical spine injury in young children: a National Trauma Data Bank review. J Pediatr Surg 43(9):1718–1721CrossRef PubMed
  24.Shacked I, Ram Z, Hadani M (1993) The anterior cervical approach for traumatic injuries to the cervical spine in children. Clin Orthop Relat Res 292:144–150PubMed
  25.Sherk HH, Nicholson JT, Chung SM (1978) Fractures of the odontoid process in young children. J Bone Joint Surg Am 60:921–924PubMed
  26.Schippers N, Konings P, Hassler W, et al. (1990) Typical and atypical fractures of the odontoid process in young children. Report of two cases and a review of the literature. Acta Neurochir 138:524–530CrossRef
  27.Shaw M, Burnett H, Wilson A, et al. (1999) Pseudosubluxation of C2 on C3 in polytraumatized children—prevalence and significance. Clin Radiol 54:377–380CrossRef PubMed
  28.Tokunaga S, Ishii Y, Aizawa T, et al. (2011) Remodeling capacity of malunited odontoid process fractures in kyphotic angulation in infancy: an observation up to maturity in three patients. Spine 1;36(23):E1515–1518
  29.Wang JC, Nuccion SL, Feighan JE, et al. (2001) Growth and development of the pediatric cervical spine documented radiographically. J Bone Joint Surg Am 83A:1212–1218
  30.Ware ML, Gupta N, Sun PP, et al. (2006) Clinical biomechanics of the pediatric craniocervical junction and the subaxial spine. In: Brockmeyer DL (ed) Advanced pediatric craniocervical surgery. Thieme, New York, pp. 27–42
  31.Wong ST, Zovickian J, Hou Y, et al. (2014) Traumatic rupture of the neurocentral synchondrosis of the axis in a child. J Neurosurg Pediatr 23(5):548–552CrossRef
  
• 作者单位：Berje Shammassian (1)
  Christina Huang Wright (1)
  James Wright (1)
  Onwuzulike (3)
  Krystal L. Tomei (2)
  
  1. Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
  3. Department of Neurosciences, Division of Neurologic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
  2. Department of Neurological Surgery, University Hospitals Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Neurosurgery
  Neurosciences
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-0350

文摘

Upper cervical synchondrosis fractures are the most common types of cervical fractures in the pediatric population less than 7 years of age (Blauth et al (Eur Spine J 5:63-70, 1996); Connolly et al (Pediatr Radiol 25(Suppl1):S129-133, 1995); Mandabach et al (Pediatr Neurosurg 19(5):225-232, 1993); Schippers et al (Acta Neurochir 138:524-530, 1990)) The vast majority occur through the dentocentral or basilar synchondrosis. We present the second reported case in recent literature of a unilateral neurosynchondrosis fracture. The patient, a 4-year-old male, was initially managed conservatively with a rigid cervical collar for a period of 3 months. Despite multiple counseling sessions with family, the patient remained poorly compliant with cervical immobilization. After 3 months, imaging demonstrated partial fusion with persistent anterolisthesis of C2 on C3. The decision was made to place the child in external halo fixation as an attempt to achieve fusion prior to committing to internal surgical fixation and the associated sequelae. Immobilization with a hard cervical collar is often first line treatment. In the case of failed fusion, debate exists regarding surgical fixation in children. Occipito-atlanto-axial fusion leads to permanent loss of a significant degree of flexion, extension, and rotatory movement. The pediatric population has a strong propensity to fuse; however, compliance is often a barrier to conservative treatment due to age-related behavioral practices. We demonstrate that even with initial failed fusion and progression of deformity while in a cervical collar, conservative management with external halo fixation can potentially obviate the need for internal fixation.